Malaria: 70% Of Under-Five Lack Access To Treatment

By Chioma Umeha

Dr. Godwin Ntadom is Head of Case Management Branch, National Malaria Elimination Programme (NMEP). In this interview with CHIOMA UMEHA, Ntadom who takes a look at current malaria situation in the country, says, children and women are the most vulnerable to Malaria. Excerpts:

Can you describe current malaria situation in Nigeria?

Nigeria accounts for a quarter of Malaria burden in Africa. Malaria is endemic in Nigeria with all year round transmission. About 97 per cent of total population is at risk of the disease. Based on the average prevalence distribution of malaria in the country, the North East, 26 per cent; North Central is 32 per cent; South West, 17 per cent; South South and 19 per cent. Malaria prevalence was highest in the Northwest with 37 per cent and lowest in the South East which had 14 per cent. The under-five (U5) mortality has reduced from 201/1000 in 2003 to157/1000 in 2008 and 128/1000 in 2013 according to the Nigeria Demographic and Health Survey (NDHS).

Malaria prevalence in Nigeria ranges from 5.1 per cent, in Imo state to 63.6 per cent in Kebbi state. Slide Positivity Rate (SPR) was zero in selected clusters in Lagos state. The 2015 Nigeria Malaria Indicator Survey (NMIS) further indicates that 27 per cent prevalence. This varies from 64 per cent in Kebbi to < one per cent in Lagos. According to the survey, average prevalence of Malaria in Lagos is two per cent. This is because Lagos has been able to bring down the parasite. If you are living in Lagos and you are sick, don’t think of Malaria. Make sure you do a rapid diagnostic test (RDT) to confirm.

We need more diagnosis than medicines. Nigerians are taking more anti-malaria when they don’t need it. The slide positivity rate for children U5 in Nigeria is 35 per cent. Of those who sought treatment for fever, 57 per cent are from the private sector, 35 per cent in public sector and nine per cent went to others like traditional healers. There has been so much improvement in malaria control in Nigeria so far as the average prevalence has declined from 42 per cent in 2010 to 27 per cent in 2015. It shows the work we have put in place and the efforts of global organisations in their support to the fight against malaria in Nigeria.

What determines the frequency of malaria transmission by any mosquito specie?

There are over 2700 species of mosquito and when it comes to anopheles mosquitoes, we just have few of them, and only 40 can transmit malaria. In Nigeria, we have four major ones that can transmit malaria parasites. Unless the female anopheles mosquitoes that are infected with the parasites bite you, you cannot have malaria. So it is not every mosquito bite that can give you malaria. That mosquito has to be infected. How does it happen? That mosquito must have bitten somebody who has the parasite and the mosquito bites that person, that mosquito becomes infected for life and any bite it makes, it must infect somebody. If you go to some countries in the world, they have mosquitoes, but the citizens themselves are not infected with the parasites.

Pregnant women and children bear the highest health burden and effects of Malaria. Can you explain?

Nigeria amount to a quarter of the population of sub-Saharan Africa. We have population close to 180 million and the people who suffer from malaria are the children and the pregnant women. Malaria causes 30 per cent of childhood mortality and 11 per cent of maternal mortality.

When you are living in malaria endemic zone, your body begins to develop some partial immunity. Partial immunity in the sense that, the continuous bite from mosquito and the continuous injection of parasite will then make your body to begin to develop some anti-bodies that will fight back the parasite, but not strong enough to prevent you from having malaria.

But, children do not have this opportunity. Children suffer more from malaria because they have not developed that partial immunity. Unfortunately, only 30 per cent of U5s receive treatment within 24 hours of onset of symptoms. So they are still very vulnerable.

Another vulnerable group of people are the pregnant women. The challenge with pregnant women is even more alarming. As a pregnant woman, you shouldn’t forget that the parasites are living things and as such they feed. So when these parasites enter the body of a pregnant woman, they might go to the placenta and feed on the food meant for the baby in the placenta and because the parasites are in a comfortable environment, they multiply and replenish themselves. That is what they do within the placenta. After sometime, they may not be enough food for the parasites, meaning, all the food that goes into the placenta are completely eaten by the parasites, leaving nothing for the baby to feed from.

At that point, since there is a separation between the human blood and the foetus blood, the woman herself may not feel anything, because what actually make one have symptoms of malaria is the waste material excreted by the parasites. The body sees the waste material as a foreign thing and reacts to it. Without all those waste materials, you will not know anything that is happening within you. Now, because all these things are happening within the placenta, the pregnant woman is not aware and she is not sick. At that point, the foetus is already going to die from food, because food is no longer getting to it and when there is no food supply again, the foetus will not grow again and if this continues, the foetus may finally die. If it is a stubborn one that does not want to die, they come as low birth weight (LBW) infants.

Low birth weight infants form more than three per cent of the causes of death in new born babies. You can see where malaria comes in. The pregnant woman is not aware of all this because the whole process is not happening within her own blood system, and if you do test for her, probably, it may be negative, because the malaria parasites, in their wisdom are more comfortable within the placenta. The only time the woman can have symptoms is when the parasite excrete waste material to her blood, and by that time, the foetus may be at a point of dying or even died. At that time, when the woman decided to take drug, the baby in her womb may die because it has not been feeding on anything and it has suffered to a point that death has become inevitable.

These are one of the hidden challenges that we have. This can be severe that the woman can lose her life in the process of trying to bring out the dead foetus from her womb. So malaria during pregnancy is the major focus when you come to malaria control programme in Nigeria. Malaria is also the most common cause of outpatient attendance. Approximately 50 per cent of population has a malaria episode annually.

Can you measure the social effects of Malaria?

Some of the social effects of Malaria include: High levels of school absenteeism; low productivity and pressure on state and local government capacity.

What about the economic consequences?

Annually, N480 billion is lost due to Malaria absenteeism and treatment costs. Similarly, Malaria is responsible for 46 per cent of all curative health costs.

Malaria is also responsible for redirection of finances from health maintenance (example, good nutrition, proper hygiene) to treatment.

The NMEP has a new policy and strategic plan. What does it say?

Yes. The goal of the new NMEP Policy is to give direction towards the elimination of malaria in the country in line with the Nigeria Vision 20:2020. It has six objectives that explain massive scale up interventions to ensure reduction of the disease burden in the country. It addresses the core issues related to malaria prevention, diagnosis, treatment, communication & social mobilization and the regulations regarding antimalarial commodities. It also expresses the intentions of Government regarding engagement of partners and private sector participation at all levels.

The vision of the NMEP Strategic Plan is to ensure a malaria free Nigeria from 2014 to 2020. The Malaria elimination key strategies of NMSP from 2014 to 2020 include: Use of long lasting insecticidal nets, indoor residual spraying, prompt diagnosis and effective treatment, malaria in pregnancy.

Other key interventions are: Larval source management (Larviciding and Environmental Management); advocacy communication and social mobilization; monitoring and evaluation and effective programme coordination.